LAUSR

Abstract Background Many prescribers may question the safety of restricting antibiotic use at their own institution. Measurement of potential adverse outcomes relevant to antimicrobial stewardship may increase the acceptability of stewardship interventions. Methods Antibiotic prescribing, admit/discharge/transfer (ADT) data, vital sign (VS) trends, white blood cell counts (WBC), microbiology antibiotic susceptibility results (ASR), and medication administration record (MAR) data were reviewed for 2620 patients hospitalized at Lurie Children’s Hospital from April 2013 to March 2017. Metrics were created using discrete data elements derived from the electronic health record (EHR). The sensitivity (to detect an adverse outcome) and specificity (to avoid false detection of an adverse outcome) were measured in comparison to manual review of the medical record. Data were presented to 50 pediatricians and pediatric subspecialists who were asked to rate (Likert scale 1–5) the perceived importance of the metrics for patient safety and usefulness of the metrics for their prescribing. Results The metrics, data elements, sensitivity, specificity, and ratings by prescribers for importance and usefulness are listed below. Conclusion Metrics derived from the EHR can offer automated surveillance of infection-related adverse outcomes relevant to antimicrobial stewardship. At the institutional level, these metrics are a potential tool to ensure the safety and acceptability of stewardship interventions. Potential Adverse Outcome Data Elements Number of Episodes Reviewed Sensitivity Specificity Importance (Mean) Usefulness (Mean) Isolated organism not susceptible to empiric therapy for positive culture at sterile body site Pharmacy orders ASR 800 86% 85% 4.8 4.3 Disagreement between rapid diagnostic test result and culture result Pharmacy orders ASR 430 95% 81% 4.2 4.5 Antibiotic restart within 7 days after initial discontinuation MAR Abnormal WBC Fever>
38 F 1200 81% 75% 3.8 3.6 IV restarts or readmissions after IV to PO conversion ADT MAR Abnormal WBC Fever>
38 F 2100 87% 94% 3.8 3.4 Disclosures S. Patel, Merck Pharmaceuticals: Investigator, Research grant; R. Patel, Merck Pharmaceuticals: Investigator, Research grant; L. Kociolek, Merck Pharmaceuticals: Investigator, Research grant.